25.2.4.5 Technical Denials (DRG Prospective Payment and TEFRA)On Site Reviews The following information describes on site reviews:
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• Note: A notarized business record affidavit is required for paper and electronic copies of requested medical records. A provider failing to provide this documentation must resubmit the requested records with the affidavit. Refer to: "Retention of Records and Access to Records and Premises" . Mail-In Reviews If the complete medical record is not received by HHSC within the specified time frame, a preliminary technical denial is issued by certified mail or fax machine. The hospital has 60 calendar days from the date of receipt of the notice to submit the complete medical record. If the complete medical record is not received by HHSC within this specified time frame, a final technical denial is issued and payment is recouped. Hospital inpatient claim payments that have been recouped because of a technical denial may not be rebilled on an outpatient claim. Note: A notarized business record affidavit is required for paper and electronic copies of requested medical records. A provider who fails to provide this documentation must resubmit the requested records with the affidavit. Refer to: "Retention of Records and Access to Records and Premises" . |
If the complete medical record is not made available during the on site review, a preliminary technical denial is issued on site. The hospital is allowed 60 calendar days from the date of the exit conference to provide the complete medical record to HHSC. If the complete medical record is not received by HHSC within this specified time frame, a final technical denial is issued and payment is recouped.
